Multidisciplinary Specialty Care Imperative for Neurofibromatosis Management

Penn State Health Milton S. Hershey Medical Center specialists are working together to form a center for the comprehensive, multidisciplinary management of patients with neurofibromatosis (NF). Leading the team are Dawit Aregawi, MD, assistant professor, neuro-oncology, Kimberly S. Harbaugh, MD, associate professor of neurosurgery, chief, division of peripheral nerve surgery, and Elias Rizk, MD, assistant professor of neurosurgery. The Hershey Medical Center team is focused on adult NF management for better function preservation, earlier detection of cases with malignant tumor progression and better management of associated comorbidities. Dr. Harbaugh explains, “If patients have access to regular monitoring at an NF specialty center closer to their homes, it’s likely that tumors and associated complications will be detected earlier, possibly helping to avoid significant nerve and soft tissue damage and to preserve function.” Dr. Aregawi says, “Despite the fact that NF is a fairly common autosomal dominant disorder [1 in 3,000]¹, many adult patients are seen by specialists only when a problem arises, with routine follow-up mostly done in the primary care setting.” A major barrier to accessing specialty care is the limited care options closer to patients’ homes, with many required to travel long distances to see an NF specialist.

An image of coronal STIR weighted pelvic MR of a patient with NF1. The larger round tumor in the lower left of the image was malignant and was removed after chemo and radiation therapy.

An image of coronal STIR weighted pelvic MR of a patient with NF1. The larger round tumor in the lower left of the image was malignant and was removed after chemo and radiation therapy.

Adult NF patients often have very broad and complex medical needs. There are elevated risks for other diseases, such as hypertension, cataracts, breast and colon cancer, in addition to the well understood risks for malignant and nonmalignant brain and peripheral nerve tumors that can cause pain and loss of function. Most adult NF patients require treatment or consultations with a variety of specialists including a neurosurgeon, neuro-oncologist, genetic counselor, neuro-ophthalmologist, dermatologist, orthopaedic surgeons and plastic surgeons. A designated NF clinic serves as a home base and portal for access to this multidisciplinary care, making care coordination more seamless for both patients and providers.

Access to the NF clinic could also improve NF detection amongst family members and provide timely genetic counseling. Dr. Aregawi adds, “The course of NF is highly variable, even among close family members, so risks are difficult to estimate based on family history.” Dr. Harbaugh says, “With such complex needs, patients and physicians caring for those with NF need support and education. There are some very dedicated organizations that provide support and fund research, like the NF Tumor Foundation and the Children’s Tumor Foundation.”

The NF clinic specialists, Drs. Aregawi, Harbaugh and Rizk, focused primarily on adult NF patients in the past. Recently, they have started seeing pediatric patients and plan to incorporate additional pediatric specialty clinicians. They further plan to integrate clinical and bench-level NF research into the clinic program. Dr. Rizk notes, “Our basic science research is progressing rapidly and we are excited about prospects for clinical trials in the near future.”

Dawit Aregawi, M.D.Dawit Aregawi, MD
Assistant Professor of Neurosurgery, Neuro-Oncology
PHONE: 717-531-3828
FELLOWSHIP: Neuro-Oncology, National Institute of Health; Hematology/Oncology, University of Michigan Medical School, Ann Arbor, Mich.; Neuro-Oncology, University of Virginia Medical Center, Charlottesville, Va.
RESIDENCY: Internal Medicine, Jewish Hospital of Cincinnati, Ohio
MEDICAL SCHOOL: Jimma Institute of Health Sciences, Ethiopia


Kimberly S. Harbaugh, M.D.Kimberly S. Harbaugh, M.D.
Associate Professor of Neurosurgery
Chief, Division of Peripheral Nerve Surgery
PHONE: 717-531-3828
RESIDENCY: Neurological surgery, Dartmouth Hitchcock Medical Center, Lebanon, N.H.; General surgery, Dartmouth Hitchcock Medical Center, Lebanon, N.H.
MEDICAL SCHOOL: University of California – San Diego, School of Medicine, San Diego, Calif.


Elias Rizk, M.D.Elias Rizk, MD
Assistant Professor of Neurosurgery
PHONE: 717-531-3828
FELLOWSHIP: Neurological surgery, Pediatrics, Birmingham Children’s Hospital
RESIDENCY: Neurological surgery, Milton S. Hershey Medical Center
INTERNSHIP: Surgery, General, Milton S. Hershey Medical Center
MEDICAL SCHOOL: American University of Beirut Medical Center


Widemann BC, Acosta MT, Ammoun S, et al. 2014. CTF meeting 2012: Translation of the basic understanding of the biology and genetics of NF1, NF2, and schwannomatosis toward the development of effective therapies. Am J Med Genet A. Mar; 164A(3):563-78.

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